Triple Aim Results @DerekFeeleyIHI Derek Feeley President and CEO - - PowerPoint PPT Presentation
May 2016 Accelerating Triple Aim Results @DerekFeeleyIHI Derek Feeley President and CEO Institute for Healthcare Improvement What is the Triple Aim? System designs that simultaneously improve three dimensions: Improving the health of
May 2016 Derek Feeley
President and CEO Institute for Healthcare Improvement
System designs that simultaneously improve three dimensions:
– Improving the health of the populations; – Improving the patient experience of care
(including quality and satisfaction); and
– Reducing the per capita cost of health
care.
Aim: Apply the Triple Aim to a population served by your organization or a population
Choose a relevant Population for improved health, care and lowered cost Articulate a Purpose that will hold your stakeholders together Develop a Systems approach Create a Learning System and choose Measures that will show improvement for the population Develop a Portfolio (group) of projects that will yield Triple Aim results
No individual project can accomplish the Triple Aim but a portfolio of projects that are executed well can move closer to the aims.
Build a Team of individuals who can manage this work: Executive Sponsor, Portfolio Lead, Project Lead, Content Expert, Improvement Advisor and Measurement Lead Develop a brisk and realistic plan for Execution on projects and accountabilities for results
Leadership Learning System Getting to Full Scale
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
What leaders do to make a difference
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce
Asking not telling Partnerships (staff, patients, communities) Shaping culture
“If a goal of conversation is to improve communication and build a relationship, then telling is more risky than asking. Asking temporarily empowers the other person and temporarily makes me vulnerable.”
“Wide lugs an a short tongue is best” Scottish Proverb
NEW PUBLIC MANAGEMENT Targets, sanctions, inspections
QUALITY IMPROVEMENT CO-PRODUCTION
Outcomes Inquiry
Sharing power Keeping power
Ceding power
Explicit Culture – Heroes, Symbols, Structures Implicit Culture – Values, Beliefs, Assumptions, Purpose
“The only thing of real importance that leaders do is to create and manage culture.”
Culture is a result of what an organization has learned from dealing with problems and organizing itself internally Your culture always helps and hinders problem solving Culture is a group phenomenon Don’t focus on culture because it can be a bottomless pit. Instead, get groups involved in solving problems
Whittington et al. Pursuing the Triple Aim: The First 7 Years. The Milbank Quarterly, Vol. 93, No. 2, 2015 (pp. 263-300)
Sub population Primary care Role of patients & families Cost control Prevention and health promotion Integration Micro &Macro Employed people <65
Focus on disability and workers comp trends
company wellness programs
advice Employer & Health System integrated approach (e.g. Onsite clinical staff)
People>65
“Home is the hub” End of life care Support for staying in the home if desired Multiple specialists
Socially complex
Strong mental health component Strengthen family support mechanisms Self help programs Integration w/ public health& social services
Children and families
Transition to adult care Support for parenting skills Immunizations and well child care Cooperation with schools
IHI Triple Aim Collaborative 2009
‘This model is not magic, but it is probably the most useful single framework I have encountered in twenty years of my own work on quality improvement’
Dr Donald M. Berwick Former President IHI, Professor of Paediatrics and Health Care Policy at the Harvard Medical School
Triage
Diagnostic Testing
Fast Track Patients Capacity/ Demand
Set-up Build Scalable Unit Test Scale- Up Go to Full-Scale
Phases of Scale-up
Best Practice exists New Scale- up Idea
Adoption Mechanisms Support Systems
Leadership, communication, social networks, culture of urgency and persistence Learning systems, data systems, infrastructure for scale-up, human capacity for scale-up, capability for scale-up, sustainability
Executive mandate Emergency mobilization Extension agency Breakthrough Series Collaborative model Campaign model Fishbowl Commercialization Grassroots organizing (one-to-ones) “Wedge and spread” (wave sequence) “Broad and deep” And many more…
Typical Exceptional They invest in comprehensive strategy development. They have a bias toward starting. They have general goals for adoption. They have explicit national and local aims. (Aim Primacy) Leadership creates standards. Leadership removes barriers. They have “theory lock.” Improvisation is a virtue. Data is for assessment. Data is for rapid adjustment.
Mark Freeman The International Journal of Management Education, 2012
policy1n pl -cies1. (Government, Politics & Diplomacy) a plan of action adopted or pursued by an individual, government, party, business, etc
UK National School for Government 2006
Evidence
Experience & Expertise Judgment Resources Values Habits & Traditions Lobbyists & Pressure Groups Pragmatics & Contingencies
Continuity Co-ordination Care closer to home Quality of life Costs
26
social care integration
More people have 2 or more conditions than only have 1
JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors
30
Cross sector collaborative to support innovation and test and spread actions which collectively improve outcomes
Outpatient (1 year) Emergency Department (1 year) Prescribing (1 year) Outcome Year (1 year) OUTCOME PERIOD Hospitalisation (3 years) PRE-PREDICTION PERIOD Psychiatric Admission (3 years) Any recent admissions to a psychiatric unit ? Any A&E attendances in the past year? What type of
appointments did the patient have? Any prescriptions for e.g. dementia drugs? Or substance dependence? How many outpatient appointments? What age is the patient? How many previous emergency admissions has the patient had? How many prescriptions? Any previous admissions for a long term condition (such as epilepsy?
Supported at Home 76% are managed in their own home instead of Hospital by the ASSET team
2,864 Patients accepted by ASSET in 29 Months 5.6 / Day
5.7 days
Length of Stay
76%
Beds Closed
50
Value £2Million+
North Lanarkshire
Has a medical home (continuity of care) 83 73 70 65 56 53 52 51 49 48 48 33 10 20 30 40 50 60 70 80 90 100 SCO rUK SWIZ NZ US NOR FR AUS CAN NETH GER SWE
Charts from 2011 Commonwealth Fund Survey of Sicker Adults
Coordination: Experienced coordination gaps in the past two years
Experienced coordination gaps in past two years 17 20 23 30 36 37 39 40 42 43 53 56 10 20 30 40 50 60 70 80 90 100 SCO rUK SWIZ NZ AUS NETH SWE CAN US NOR FR GER
Charts from 2011 Commonwealth Fund Survey of Sicker Adults
Commonwealth Fund 2011 Sicker adults Survey
Same or next day appointment 83 79 79 75 75 70 63 59 59 59 51 50 10 20 30 40 50 60 70 80 90 100 SCO rUK SWIZ NZ FR NETH AUS US NOR GER CAN SWE Waited six days or more 2 2 4 5 8 10 12 14 16 22 23 23 10 20 30 40 50 60 70 80 90 100 SCO rUK SWIZ NZ FR AUS NETH NOR US SWE CAN GER
Care close to home: Access to doctor or nurse when sick or needed care
37
4000 4500 5000 5500 6000 6500 Mar-06 Mar-07 Mar-08 Mar-09 Mar-10 Mar-11
Year ending Bedday rate per 1000 aged 75+ Borders Lothian Board average Highland Ayrshire & Arran Tayside Sept-11
Re-shaping Care Prog/LTC Prog
Quality of life: Bed day rate for patients aged 75+ (emergency admissions)
550 Beds
39%
CHANGE FUND SPEND 2014/15 SUPPORTED CARERS
2.5
Million
MORE DAYS IN OWN HOME THAN ‘EXPECTED’
17%
FEWER
OLDER PEOPLE CONVEYED to HOSPITAL after a fall (non-injured)
10% REDUCTION
IN RATE OF 75+ EMERGENCY BEDDAYS OVER 5 YEARS
1250
PER DAY
FEWER PEOPLE AGED 65+ IN HOSPITAL BEDS THAN ‘EXPECTED’ IN RECEIPT OF FORMAL CARE AT HOME HAVE TELECARE
5500 PER DAY
FEWER PEOPLE IN CARE HOMES THAN ‘EXPECTED’
19% FEWER
PEOPLE DELAYED IN HOSPITAL OVER 2 WEEKS